<!--
  ========================LICENSE_START=================================
  screenit-web
  %%
  Copyright (C) 2012 - 2020 Facilitaire Samenwerking Bevolkingsonderzoek
  %%
  This program is free software: you can redistribute it and/or modify
  it under the terms of the GNU Affero General Public License as published by
  the Free Software Foundation, either version 3 of the License, or
  (at your option) any later version.
  
  This program is distributed in the hope that it will be useful,
  but WITHOUT ANY WARRANTY; without even the implied warranty of
  MERCHANTABILITY or FITNESS FOR A PARTICULAR PURPOSE.  See the
  GNU General Public License for more details.
  
  You should have received a copy of the GNU Affero General Public License
  along with this program.  If not, see <http://www.gnu.org/licenses/>.
  =========================LICENSE_END==================================
  -->
<html xmlns:wicket="http://wicket.apache.org/">
<wicket:panel>
	<fieldset>
		<div class="row-fluid">
			<div class="span12">
				<h2>(Samenvoeg)velden</h2>							
				<div class="accordion" wicket:id="container" data-chevron-direction="left">
					<div class="accordion-group samenvoegvelden" wicket:id="mergeTypes">
						<div class="accordion-heading header-samenvoegvelden">
							 <a class="accordion-toggle" data-toggle="collapse" wicket:id="collapseLink"><i class="icon-purple pull-right icon-chevron-left"></i>
			                    <wicket:container wicket:id="mergeTypeLabel">Landelijke parameters</wicket:container>
			                </a>										
						</div>
						<div class="accordion-body collapse" wicket:id="content">
						<div class="accordion-inner">
							<wicket:enclosure child="fromDB">
							<div class="row-fluid">
								<div class="span6">
									<div class="control-group">
										<label wicket:id="fromDBLabel" class="control-label">Gegevens uit
											database?:</label>
										<input wicket:id="fromDB" type="checkbox" class="fromDB">
									</div>
								</div>
								<div class="span6">
									<wicket:enclosure child="extraField">
									<div class="control-group">
										<label class="control-label">Ondertekenaar:</label>
										<div class="controls" wicket:id="extraField"></div>
									</div>					
									</wicket:enclosure>				
								</div>
							</div>
							<hr>
							</wicket:enclosure>

							<wicket:container wicket:id="fields"/>
							</div>
						</div>
					</div>
				</div>
			</div>
		</div>
	</fieldset>
	<div wicket:id="printDialog"></div>

	<wicket:fragment wicket:id="fragmentMergeFields">
		<div class="control-group" wicket:id="mergeFields">
			<label class="control-label" wicket:id="fieldName"></label>
			<div wicket:id="invoerField"></div>
		</div>
	</wicket:fragment>
	<wicket:fragment wicket:id="fragmentClientFields">
		<div class="row-fluid">
			<div class="span6">
				<div class="control-group">
					<label class="control-label">Bsn </label>
					<div class="controls">
						<input class="form-control input-small" type="text" placeholder="123456789" wicket:id="bsn">
                           <span class="add-on" wicket:id="bsnGenereren"><i class="icon-refresh"></i></span>
					</div>
				</div>

				<div class="control-group">
					<label class="control-label">Titel </label>
					<div class="controls">
						<select wicket:id="titel">
						</select>
					</div>
				</div>
				<div class="control-group">
					<label class="control-label">Voornamen</label>
					<div class="controls">
						<input class="input-large" type="text"
							wicket:id="voornaam">
					</div>
				</div>
				<div class="control-group">
					<label class="control-label">Achternaam</label>
					<div class="controls">
						<input class="input-large" type="text"
							wicket:id="achternaam">
					</div>
				</div>
				<div class="control-group">
					<label class="control-label">Tussenvoegsel</label>
					<div class="controls">
						<input class="input-large" type="text"
							wicket:id="tussenvoegsel">
					</div>
				</div>
				<div class="control-group">
					<label class="control-label">Geboortedatum</label>
					<div class="controls">
						<input wicket:id="geboortedatum" type="text" maxlength="10" class="input-small datum">
					</div>
				</div>

				<div class="control-group">
					<label class="control-label">Geslacht</label>
					<div class="controls">
						<select wicket:id="geslacht"></select>
					</div>
				</div>
			</div>
			<div class="span6">
				<div class="control-group">
					<label class="control-label">Straat</label>
					<div class="controls">
						<input class="input-large" type="text"
							wicket:id="gbaAdres.straat">
					</div>
				</div>
				<div class="row-fluid">
                       <div class="span6">
                           <div class="control-group">
                               <label class="control-label">Huisnummer</label>
                               <div class="controls">
                                   <input wicket:id="gbaAdres.huisnummer" class="input-small" type="text"
                                          value="">
                               </div>
                           </div>
                           <div class="control-group">
                               <label class="control-label">Huisletter</label>
                               <div class="controls">
                                   <input wicket:id="gbaAdres.huisletter" class="input-small" type="text"
                                          value="">
                               </div>
                           </div>
                       </div>
                       <div class="span6">
                           <div class="control-group">
                               <label class="control-label">Huisnummertoevoeging</label>
                               <div class="controls">
                                   <input wicket:id="gbaAdres.huisnummerToevoeging" class="input-small"
                                          type="text" value="">
                               </div>
                           </div>
                           <div class="control-group">
                               <label class="control-label">Aanduiding bij huisnummer</label>
                               <div class="controls">
                                   <input wicket:id="gbaAdres.huisnummerAanduiding" class="input-small"
                                          type="text" value="">
                               </div>
                           </div>
                       </div>
                   </div>
				<div class="control-group">
					<label class="control-label">Postcode</label>
					<div class="controls">
						<input class="input-mini" type="text" value="1234 AB"
							wicket:id="gbaAdres.postcode">
					</div>
				</div>
				<div class="control-group">
					<label class="control-label">Plaats</label>
					<div class="controls">
						<input class="input-large" type="text" value="Plaatsnaam"
							wicket:id="gbaAdres.plaats">
					</div>
				</div>
				<div class="control-group">
					<label class="control-label">Locatiebeschrijving</label>
					<div class="controls">
						<textarea wicket:id="gbaAdres.locatieBeschrijving"
							class="textarea-full-width locatiebeschrijving" cols="3"></textarea>
					</div>
				</div>
			</div>
		</div>
	</wicket:fragment>
	<wicket:fragment wicket:id="fragmentIntakeLocatieFields">
		<div class="row-fluid">
			<div class="span6">
				<div class="control-group">
					<label class="control-label">Naam organisatie </label>
					<div class="controls">
						<input class="input-xlarge" type="text"
							value="Organisatie 1" wicket:id="naam">
					</div>
				</div>
				<div class="control-group">
					<label class="control-label">Straatnaam</label>
					<div class="controls">
						<input class="input-xlarge" type="text" value="Straatnaam"
							wicket:id="adressen[0].straat">
					</div>
				</div>
				<div class="row-fluid">
                       <div class="span6">
                           <div class="control-group">
                               <label class="control-label">Huisnummer</label>
                               <div class="controls">
                                   <input wicket:id="adressen[0].huisnummer" class="input-small" type="text"
                                          value="">
                               </div>
                           </div>
                           <div class="control-group">
                               <label class="control-label">Huisletter</label>
                               <div class="controls">
                                   <input wicket:id="adressen[0].huisletter" class="input-small" type="text"
                                          value="">
                               </div>
                           </div>
                       </div>
                       <div class="span6">
                           <div class="control-group">
                               <label class="control-label">Huisnummertoevoeging</label>
                               <div class="controls">
                                   <input wicket:id="adressen[0].huisnummerToevoeging" class="input-small"
                                          type="text" value="">
                               </div>
                           </div>
                           <div class="control-group">
                               <label class="control-label">Aanduiding bij huisnummer</label>
                               <div class="controls">
                                   <input wicket:id="adressen[0].huisnummerAanduiding" class="input-small"
                                          type="text" value="">
                               </div>
                           </div>
                       </div>
                   </div>
				<div class="control-group">
					<label class="control-label">Postcode</label>
					<div class="controls">
						<input class="input-mini" type="text" value="1234 AB"
							wicket:id="adressen[0].postcode">
					</div>
				</div>
				<div class="control-group">
					<label class="control-label">Plaats</label>
					<div class="controls">
						<input class="input-large" type="text" value="Plaatsnaam"
							wicket:id="adressen[0].plaats">
					</div>
				</div>
				<div class="control-group">
					<label class="control-label">Postbusnummer</label>
					<div class="controls">
						<input class="input-small" type="text" value="1233"
							wicket:id="adressen[1].huisnummer">
					</div>
				</div>
				<div class="control-group">
					<label class="control-label">Postbusnummer postcode</label>
					<div class="controls">
						<input class="input-mini" type="text" value="4321 ZY"
							wicket:id="adressen[1].postcode">
					</div>
				</div>
				<div class="control-group">
					<label class="control-label">Postbusnummer plaats</label>
					<div class="controls">
						<input class="input-large" type="text" value="Plaatsnaam"
							wicket:id="adressen[1].plaats">
					</div>
				</div>
			</div>
			<div class="span6">
				<div class="control-group">
					<label class="control-label">Telefoonnummer 1</label>
					<div class="controls">
						<input class="input-medium" type="text"
							wicket:id="telefoon">
					</div>
				</div>
				<div class="control-group">
					<label class="control-label">Faxnummer</label>
					<div class="controls">
						<input class="input-medium" type="text" wicket:id="fax">
					</div>
				</div>
				<div class="control-group">
					<label class="control-label">E-mail</label>
					<div class="controls">
						<input class="input-large" type="text" wicket:id="email">
					</div>
				</div>
				<div class="control-group">
					<label class="control-label">Website</label>
					<div class="controls">
						<input class="input-large" type="text" wicket:id="website">
					</div>
				</div>
				<div class="control-group">
					<label class="control-label">Locatiebeschrijving</label>
					<div class="controls">
						<textarea wicket:id="locatieBeschrijving"
							class="textarea-full-width locatiebeschrijving" cols="3"></textarea>
					</div>
				</div>
				<div class="control-group">
					<label class="control-label">Tijdsduur intake</label>
					<div class="controls">
						<select wicket:id="duurAfspraakInMinuten"></select> 
					</div>
				</div>
			</div>
		</div>
	</wicket:fragment>
	<wicket:fragment wicket:id="fragmentDatePicker">
		<div class="controls input-append" style="margin-left: 185px">
			<input wicket:id="formComponent" class="input-medium" type="text" />
			<a href="javascript:void(0);" class="add-on"
			   onclick="$(this).prev().datepicker('show');return false;"
			   title="Datum" tabindex="-1"><i class="icon-calendar"></i></a>
		</div>
	</wicket:fragment>
	<wicket:fragment wicket:id="fragmentText">
		<div class="controls" style="margin-left: 345px">
			<input wicket:id="formComponent" class="input-medium" type="text" />
		</div>
	</wicket:fragment>
	<wicket:fragment wicket:id="fragmentBoolean">
		<div class="controls" wicket:id="formComponent" style="margin-left: 355px">
		</div>
	</wicket:fragment>
    <wicket:fragment wicket:id="fragmentEnum">
        <div class="controls">
           	<span wicket:id="formContainer"> <select wicket:id="formComponent" style="margin-left: 165px">
		   	</select></span>
        </div>
    </wicket:fragment>
	<wicket:fragment wicket:id="fragmentMammaAfspraakRedenVerzet">
		<div class="controls">
			<span wicket:id="formContainer"><select wicket:id="formComponent" style="margin-left: 165px">
			</select></span>
		</div>
	</wicket:fragment>
	<wicket:fragment wicket:id="fragmentBKRadioloogOndertekenaar">
		<div class="controls">
			<input class="input-medium" type="text" wicket:id="textField"></input>
			<span wicket:id="formContainer"><select wicket:id="formComponent" style="margin-left: 165px">
			</select></span>
		</div>
	</wicket:fragment>
</wicket:panel>
</html>
